Provider Demographics
NPI:1639951957
Name:MULLIGAN, TINA-ANNE DOROTHY (LPC)
Entity Type:Individual
Prefix:MS
First Name:TINA-ANNE
Middle Name:DOROTHY
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 GODWIN AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-2928
Mailing Address - Country:US
Mailing Address - Phone:201-249-6655
Mailing Address - Fax:
Practice Address - Street 1:317 GODWIN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1547
Practice Address - Country:US
Practice Address - Phone:201-249-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00956900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health